Healthcare Provider Details

I. General information

NPI: 1497402796
Provider Name (Legal Business Name): JOSEPH ANTHONY SANDOVAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SPURS LN STE 340
SAN ANTONIO TX
78240-1680
US

IV. Provider business mailing address

7505 N LOOP 1604 E STE 101
LIVE OAK TX
78233-2604
US

V. Phone/Fax

Practice location:
  • Phone: 210-798-8585
  • Fax:
Mailing address:
  • Phone: 210-590-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: